Tarsal Coalition | Diagnosis & Treatments
How is tarsal coalition diagnosed?
The first step to treating your child’s tarsal coalition is to form a timely, complete, and accurate diagnosis. To diagnose your child’s condition, their doctor will conduct a physical exam. During the exam, the doctor will take your child’s complete prenatal, birth, and family medical history. They will also order standing x-rays as the initial imaging tool.
To confirm the diagnosis and give valuable information about the type of coalition, its location, and how the joints have been affected, either of the following diagnostic tests may be performed:
- Computerized tomography scan (CT or CAT scan): Considered the gold standard for diagnosing tarsal coalitions, a CT scan is a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional horizontal and vertical images (called "slices") of the body. A CT scan shows detailed images of any part of the body — including bones, muscles, fat, and organs.
- Magnetic resonance imaging (MRI): An MRI is a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body. This test is done to rule out any associated abnormalities of the spinal cord and nerves.
Images will probably be taken of both of your child’s feet, even if only one foot is painful. This is because sometimes the child can have the condition in both feet (bilateral), yet only one foot is painful.
How is tarsal coalition treated?
About 75 percent of children with tarsal coalition never need treatment. And of the 25 percent who do, up to one half don't need surgery.
Your child's physician will determine whether your child needs treatment and what that will be determined by based on:
- your child's age, overall health, and medical history
- the extent of the condition
- your child's tolerance for specific medications, procedures, or therapies
- expectations for the course of the condition
Non-surgical treatments
The primary goal of conservative, non-surgical treatment is to reduce pain and muscle spasms by further reducing range of motion (immobilization) in the affected joint or joints. Treatments can include:
- casts or walking boots
- orthotics — special, custom-made shoe inserts that support affected joints
- injection of an anesthetic and a steroid, such as cortisone, for temporary pain relief
- anti-inflammatory medications
- stretching and physical therapy
Surgical treatments
If your child's pain persists or recurs despite conservative measures, your child's doctor will probably recommend surgery.
- The type of surgery depends on the type and location of the coalition, whether arthritis is involved, and, if it is, how extensive the arthritis is.
- If there are no arthritic changes, the union between the bones is usually removed (resected), with fat or muscle placed where the tarsal coalition was so that normal range of motion can occur.
- In more severe cases, surgery is aimed at limiting the range of motion in the joint that causes pain. In this instance, the surgery involves fusing affected joints to reduce pain.
After surgery, as part of the recovery process, a splint or cast, along with crutches, are used to immobilize the foot and keep the foot from bearing weight. Exercises to restore muscle tone and range of motion are encouraged as early as one to two weeks after surgery. Walking and full strengthening begins about one month after surgery.
Care after surgery
After surgery, your child will probably stay in the hospital overnight, and be given pain medication. They will wear a cast when they go home and will need to limit their weight-bearing activities for about a month. They may use crutches or a walker for a few weeks. At this point, therapy is aimed mostly at regaining range of motion and preventing the bone bridge (coalition) from reforming.
After about a month your child will transition into a walking boot and begin strengthening exercises. Physical therapy will help restore their muscle strength. They'll probably be able to resume full activities, including sports, after three to six months. However, a full recovery can take up to a year.
What is the long-term outlook for my child with tarsal coalition?
Only a small percentage of children with tarsal coalition need treatment for it. And one-third to one-half of those who need treatment can be treated without surgery.
Of those who are treated either non-surgically or surgically, about 75 percent become free from pain and do not have a recurrence of the condition.
There is a risk that the repaired joints or surrounding joints may develop arthritis later in your child’s life.
Tarsal Coalition | Research & Clinical Trials
Research & Innovation
For more than a century, orthopedic surgeons and investigators at Boston Children’s Hospital have played a vital role in advancing the field of musculoskeletal research. We’ve developed breakthrough treatments and major advances for lower limb and hip problems, as well as for scoliosis, polio, tuberculosis and traumas to the hand and upper extremities.
Our pioneering research helps answer the most pressing questions in pediatric orthopedics today—to provide children with the most innovative care available.
In Boston Children’s Hospital's Orthopedics and Sports Medicine Department, we take great pride in our basic science and clinical research leaders, who are recognized throughout the world for their achievements. Our orthopedic research team includes:
- full-time basic scientists
- 28 clinical investigators
- a team of research coordinators and statisticians
Orthopedic basic science laboratories
Working in Boston Children’s labs are some of the leading musculoskeletal researchers in the nation. Our labs include:
- Orthopedic basic science research
- Center for the study of genetic skeletal disorders
- Sports Medicine research laboratory
- Bone cell biology laboratory
- Matthew Harris lab
Children speak about what it's like to be a medical research subject
View a video of a day in the life of Boston Children's Clinical and Translational Study Unit, through the eyes of children who are “giving back” to science.
Boston Children's Hospital Hip Program's unique insight and expertise
Boston Children’s Hospital's Child and Adult Hip Preservation Program enjoys a special degree of effectiveness—not just because of our long tradition of excellence in pediatric hip care, but also because we follow our patients through adulthood. This gives us a unique perspective, insight and expertise—we can track how the hip works in each age group, how the problems evolve, and how the hip’s function changes over time in adult patients who’ve had treatment in childhood.